Utilidad del biomarcador antígeno del cáncer 125 para el diagnóstico de tuberculosis: experiencia en Cali, Colombia

Publicado

2022-07-01

Clinical usefulness of cancer antigen 125 biomarker for diagnosing tuberculosis: experience in Cali, Colombia

Utilidad del biomarcador antígeno del cáncer 125 para el diagnóstico de tuberculosis: experiencia en Cali, Colombia

Palabras clave:

Mycobacterium Tuberculosis, Tuberculosis, CA-125 Antigen, Biomarkers, Mortality (en)
Mycobacterium tuberculosis, Tuberculosis, Antígeno CA-125, Mortalidad (es)

Descargas

Autores/as

Carl Sebastian Leib Universidad Icesi - Facultad de Ciencias de la Salud - Cali - Colombia. https://orcid.org/0000-0002-6530-9450
Luis Gabriel Parra-Lara Universidad Icesi - Facultad de Ciencias de la Salud - Cali - Colombia. | Fundación Valle del Lili - Centro de Investigaciones Clínicas - Cali - Colombia. https://orcid.org/0000-0002-4877-1117
Robinson Pacheco Universidad Icesi - Facultad de Ciencias de la Salud - Cali - Colombia. https://orcid.org/0000-0003-2525-9935
José Fernando García-Goez Universidad Icesi - Facultad de Ciencias de la Salud - Cali - Colombia. | Fundación Valle del Lili - Departamento de Medicina Interna - Servicio de Enfermedades Infecciosas - Cali - Colombia. https://orcid.org/0000-0001-7947-5436

Resumen (en)
Resumen (es)

Introduction: Diagnosing extra-pulmonary tuberculosis (EPTB) is a challenge for physicians. It has been suggested that cancer antigen 125 (CA-125), which is produced by mesothelial cells, may be an EPTB diagnostic biomarker.

Objective: To describe serum CA-125 levels behavior in patients with TB treated in a referral university hospital located in Cali, Colombia.

Materials and methods: A cross-sectional study was conducted in 99 TB patients treated at Fundación Valle del Lili between 2007 and 2016 with CA-125 measurements (U/mL) made before TB treatment was started. Cases were classified as pulmonary TB (PTB) (n=33) or EPTB (n=66). A bivariate analysis was performed to compare the variables of interest (sociodemographic, clinical, and laboratory findings data) between EPTB and PTB groups, and to determine differences between patients with CA-125 positive results and those with negative results in relation to mortality.

Results: Elevated CA-125 levels were reported in 55 patients (55.56%), and positive CA-125 results (>35 U/mL) were more frequent in the EPTB group (59.09% vs. 48.48%). In the EPTB group, results were positive in tuberculous serositis cases (100% pericardial TB, 68.42% peritoneal TB, and 66.66% pleural TB), and in 66.66% of miliary TB and spinal TB cases, respectively. Also, 15 TB infection-related deaths were reported in the follow-up period (n=66), of which 13 had a CA-125 positive result, finding a significant difference with those with negative results (p=0.021); however, 47.05% of the surviving patients also had a positive result.

Conclusions: Most of tuberculous serositis, miliary TB, and spinal TB cases showed elevated CA-125 levels before starting TB treatment. Therefore, CA-125 may be useful for prognostic purposes in these patients.

Introducción. El diagnóstico de la tuberculosis extrapulmonar (TBEP) es un reto para los médicos. Se ha sugerido que el antígeno del cáncer 125 (CA-125), producido por las células mesoteliales, puede ser un biomarcador diagnóstico de TBEP.

Objetivo. Describir el comportamiento de los niveles séricos del CA-125 en pacientes con tuberculosis (TB) atendidos en un hospital de referencia de Cali, Colombia.

Materiales y métodos. Estudio transversal realizado en 99 pacientes con TB y mediciones de CA-125 (U/mL) antes de iniciar tratamiento para TB atendidos en la Fundación Valle del Lili entre 2007 y 2016. Los casos se clasificaron como TB pulmonar (TBP) (n=33) o TBEP (n=66). Se realizó un análisis bivariado para comparar las variables de interés (datos sociodemográficos, clínicos y de laboratorio) entre los grupos TBEP y TBP, y para determinar diferencias entre pacientes con resultados positivos y negativos para CA-125 en relación con la mortalidad.

Resultados. Se reportaron niveles elevados de CA-125 en 55 pacientes (55.56%). Los resultados positivos para CA-125 (>35 U/mL) fueron más frecuentes en el grupo TBEP (59.0% vs. 48.48%). En el grupo TBEP se encontraron resultados positivos en los casos de serositis tuberculosa (100% TB pericárdica, 68.42% TB peritoneal y 66.66% TB pleural), y en 66.66% de los casos de TB miliar y vertebral, respectivamente. Además, se reportaron 15 muertes relacionadas con la infección por TB en el período de seguimiento (n=66), de las cuales 13 tuvieron un resultado positivo para CA-125, encontrando una diferencia significativa con aquellas con resultados negativos (p=0.021); sin embargo, el 47.05% de los pacientes supervivientes también tuvo un resultado positivo.

Conclusiones: La mayoría de los casos de serositis tuberculosa, TB miliar y vertebral tuvieron niveles elevados de CA-125 antes de iniciar el tratamiento de la TB. El CA-125 puede resultar útil para fines de pronóstico en estos pacientes.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Diagnostic Standards and Classification of Tuberculosis in Adults and Children. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1376-95. https://doi.org/gf498d.

Centers for Disease Control and Prevention. Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep. 2009;58(1):7-10.

Foulds J, O’Brien R. New tools for the diagnosis of tuberculosis: the perspective of developing countries. Int J Tuberc Lung Dis. 1998;2(10):778-83.

Purohit M, Mustafa T. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need. J Clin Diagn Res. 2015;9(4):EE01-6. https://doi.org/jfpr.

Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47-55. https://doi.org/gpkmkr.

Ameglio F, Giannarelli D, Cordiali-Fei P, Pietravalle M, Alemanno L, Paone G, et al. Use of discriminant analysis to assess disease activity in pulmonary tuberculosis with a panel of specific and nonspecific serum markers. Am J Clin Pathol. 1994;101(6):719-25. https://doi.org/jfps.

Verbon A, Juffermans N, Van Deventer SJ, Speelman P, Van Deutekom H, Van Der Poll T. Serum concentrations of cytokines in patients with active tuberculosis (TB) and after treatment. Clin Exp Immunol. 1999;115(1):110-3. https://doi.org/fxbvzm.

Fortún J, Martín-Dávila P, Gómez-Mampaso E, Vallejo A, Cuartero C, González-García A, et al. Extra-pulmonary tuberculosis: a biomarker analysis. Infection. 2014;42(4):649-54. https://doi.org/jfpt.

Fortún J, Martín-Dávila P, Méndez R, Martínez A, Norman F, Rubi J, et al. Ca-125: a useful marker to distinguish pulmonary tuberculosis from other pulmonary infections. Open Respir Med J. 2009;3:123-7. https://doi.org/dqs3sg.

Haga Y, Sakamoto K, Egami H, Yoshimura R, Mori K, Akagi M. Clinical Significance of Serum CA125 Values in Patients with Cancers of the Digestive System. Am J Med Sci. 1986;292(1):30-4. https://doi.org/btvxvz.

Miralles C, Orea M, Espana P, Provencio M, Sánchez A, Cantos B, et al. Cancer antigen 125 associated with multiple benign and malignant pathologies. Ann Surg Oncol. 2003;10(2):150-4. https://doi.org/bmqxjj.

Niwa Y, Shimokata K. Diagnostic significance of cancer antigen 125, pancreatic oncofetal antigen, and carcinoembryonic antigen in malignant and tuberculous pleural effusions. Jpn J Clin Oncol. 1986;16(1):3-8. https://doi.org/jfpx.

Huang WC, Tseng CW, Chang KM, Hsu JY, Chen JH, Shen GH. Usefulness of tumor marker CA-125 serum levels for the follow-up of therapeutic responses in tuberculosis patients with and without serositis. Jpn J Infect Dis. 2011;64(5):367-72. https://doi.org/jfpz.

Ozsahin SL, Turgut B, Nur N, Dogan OT, Erselcan T, Berk S. Validity of the CA125 level in the differential diagnosis of pulmonary tuberculosis. Jpn J Infect Dis. 2008;61(1):68-9.

Mas MR, Cömert B, Sağlamkaya U, Yamanel L, Kuzhan O, Ateskan U, et al. CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis. Dig Liver Dis. 2000;32(7):595-7. https://doi.org/c37hcj.

Yilmaz A, Ece F, Bayramgürler B, Akkaya E, Baran R. The value of Ca 125 in the evaluation of tuberculosis activity. Respir Med. 2001;95(8):666-9. https://doi.org/cts2mh.

Sahin F, Yildiz P. Serum CA-125: biomarker of pulmonary tuberculosis activity and evaluation of response to treatment. Clin Invest Med. 2012;35(4):E223-8. https://doi.org/jfp2.

Said AF, Mohamed BI, El-Sharkawy E, Al-Sherif M. Role of cancer antigen 125 in active pulmonary tuberculosis. Egypt J Chest Dis Tuberc. 2013;62(3):419-24. https://doi.org/jfp3.

Kim ES, Park KU, Song J, Lim H-J, Cho YJ, Yoon H, et al. The clinical significance of CA-125 in pulmonary tuberculosis. Tuberculosis (Edinb). 2013;93(2):222-6. https://doi.org/f4smzx.

Gómez-Aldana AJ. Tuberculosis peritoneal con niveles elevados de CA 125. Rev. Fac. Med. 2013;61(3):311-4.

Chaves W, Buitrago JF, Dueñas A, Bejarano JC. Acerca de la tuberculosis extrapulmonar. Repert Med Cir. 2017;26(2):90-7.

Insuasty-Enríquez JS, Bolívar A, Calvo LS, Roberto SL. Tuberculosis peritoneal simulando cáncer de ovario. Acta Med Colomb. 2014;39(4):383-7.

World Health Organization (WHO). Definitions and reporting framework for tuberculosis - 2013 revision. Geneva: WHO; 2014 [cited 2021 Aug 12]. Available from: https://bit.ly/3C0hu7u.

Colombia. Ministerio de Salud y Protección Social. Resolución 227 de 2020 (febrero 20): Por medio de la cual se adoptan los lineamientos técnicos y operativos del Programa Nacinal de Prevención y Control de la Tuberculosis - PNPCT y se dictan otras disposiciones. Bogotá D.C.; [cited 2021 Aug 12]. Available from: https://bit.ly/3BjmXa7.

Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberc lung Dis. 2003;7(8):777-86.

Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263-70. https://doi.org/bsq438.

World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.

Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; October 4, 1993.

Kabawat SE, Bast RC, Welch WR, Knapp RC, Colvin RB. Immunopathologic characterization of a monoclonal antibody that recognizes common surface antigens of human ovarian tumors of serous, endometrioid, and clear cell types. Am J Clin Pathol. 1983;79(1):98-104. https://doi.org/jfs5.

Kabawat SE, Bast RC, Bhan AK, Welch WR, Knapp RC, Colvin RB. Tissue distribution of a coelomic-epithelium-related antigen recognized by the monoclonal antibody OC125. Int J Gynecol Pathol. 1983;2(3):275-85. https://doi.org/chf3wr.

O’Brien TJ, Tanimoto H, Konishi I, Gee M. More than 15 years of CA 125: what is known about the antigen, its structure and its function. Int J Biol Markers. 1998;13(4):188-95. https://doi.org/jfw3.

Nakanishi Y, Hiura K, Katoh O, Yamaguchi T, Kuroki S, Aoki Y, et al. [Clinical significance of serum CA125 in patients with tuberculous pleurisy]. Kekkaku. 1991;66(8):525-30.

O’Riordan DK, Deery A, Dorman A, Epstein OE. Increased CA 125 in a patient with tuberculous peritonitis: case report and review of published works. Gut. 1995;36(2):303-5. https://doi.org/c36kr2.

Okazaki K, Mizuno K, Katoh K, Hashimoto S, Fukuchi S. Tuberculous peritonitis with extraordinarily high serum CA125. J Med. 1992;23(5):353-61.

Imai A, Itoh T, Niwa K, Tamaya T. Elevated CA125 serum levels in a patient with tuberculous peritonitis. Arch Gynecol Obstet. 1991;248(3):157-9. https://doi.org/chc8r5.

Alimagham M, Aminiafshar S, Moghaddam SH, Shokuhi S. Two cases of miliary tuberculosis and elevated levels of cancer antigen 125. Can J Infect Dis Med Microbiol. 2006;17(2):135. https://doi.org/jfw5.

Mayosi BM, Burgess LJ, Doubell AF. Tuberculous Pericarditis. Circulation. 2005;112(23):3608-16. https://doi.org/dxsv8r.

Jeyarajah AR, Ind TE, MacDonald N, Skates S, Oram DH, Jacobs IJ. Increased mortality in postmenopausal women with serum CA125 elevation. Gynecol Oncol. 1999;73(2):242-6. https://doi.org/cjsfvk.

Sahin A, Kaya H, Avci O. Cancer antigen-125 is a predictor of mortality in patients with pulmonary arterial hypertension. Clin Biochem. 2021;89:58-62. https://doi.org/gmdwq3.

Kaya H, Zorlu A, Yucel H, Dogan OT, Sarikaya S, Aydin G, et al. Cancer antigen-125 levels predict long-term mortality in chronic obstructive pulmonary disease. Biomarkers. 2015;20(2):162-7. https://doi.org/jfw7.

Sharma SK, Mohan A, Kadhiravan T. HIV-TB co-infection: epidemiology, diagnosis & management. Indian J Med Res. 2005;121(4):550-67.

Magee MJ, Foote M, Ray SM, Gandhi NR, Kempker RR. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality. Epidemiol Infect. 2016;144(10):2209-16. https://doi.org/f8t9vx.

Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S. Adenosine deaminase for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis. PLoS One. 2019;14(3):e0213728. https://doi.org/jfw8.

Wang G, Wang S, Yang X, Sun Q, Jiang G, Huang M, et al. Accuracy of Xpert MTB/RIF Ultra for the Diagnosis of Pleural TB in a Multicenter Cohort Study. Chest. 2020;157(2):268-75. https://doi.org/ggm3vr.

Licencia

Derechos de autor 2021 Revista de la Facultad de Medicina

Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.